Annals of emergency medicine
-
The Schafer artificial respiration method, which compressed the lungs to expel water, was abandoned in 1958 when mouth-to-mouth ventilation became the primary resuscitation method. Water thus remained in the lungs, making mouth-to-mouth ineffectual for treating drowning. ⋯ The method is safe because it eliminates compression of the rib cage. The first step in resuscitating a drowning person should be subdiaphragmatic pressure repeated until water ceases to flow from the mouth.
-
Although high-dose corticosteroids have been widely recommended as an adjunctive measure in the treatment of serious decompression sickness, there are few objective data to support their efficacy in this disease. An unusual case of neurological decompression sickness which seemed to demonstrate a therapeutic response to steroids independent of recompression is presented. The various manifestations of decompression sickness and the effectiveness of delayed treatment are discussed.
-
Algorithm-directed triage by nonprofessionals was used to safely assign care urgency categories to 22,934 walk-in patients under 13 years of age during 1978. Of all patients, 16.7% were categorized as having urgent or potentially urgent problems at triage. Of those patients admitted, 79.12% received these urgency classifications. ⋯ A total of 11.16% of all patients received a routine or non-urgent classification. No patients admitted had been triaged to this non-urgent classification. As determined by review of records of 91 patients admitted from the acute care facility, the system safely identifies both high- and low-risk walk-in populations.
-
A 64-year-old man presented with a history of four days of lower abdominal pain and 12 hours of cutaneous discoloration, bullae formation, and swelling of the soft tissues of abdominal wall and right thigh. Myonecrosis of abdominal wall and an adenocarcinoma of the cecum were found at operation. Cultures of blood and fluid from the bullae yielded Clostridium septicum. ⋯ Presumptive diagnosis often can be made by Gram stain of the bullous fluid that reveals gram-positive bacilli and a paucity of leukocytes. Favorable outcome depends on prompt institution of appropriate antimicrobial therapy and surgical debridement of involved soft tissues, as well as correction of the underlying disorder. This disease should be considered to be a medical-surgical emergency.